Long-term evolution of multiple sclerosis iron rim lesions in 7 T MRI
Long-term evolution of multiple sclerosis iron rim lesions in 7 T MRI
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DOI：
10.1093/brain/awaa436
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发表时间：
2021-01-23
期刊：
影响因子：
14.5
通讯作者：
Hametner, Simon
中科院分区：
文献类型：
--
作者：
Dal-Bianco, Assunta;Grabner, Guenther;Hametner, Simon
最近的数据表明，多发性硬化症白质病变被含小胶质细胞的铁环包围，称为铁环病变，表明患者病程更严重，有发展为进行性多发性硬化症的倾向。然而，到目前为止，对铁环病变在长期随访中的动态知之甚少。在一项前瞻性纵向队列研究中，33名患者（17名女性，30名复发缓解型，3名继发性进行性多发性硬化症，中位年龄36.6岁（18.6-62.6岁）），我们通过每年扫描的7 T MRI描述了铁环病变的演变。最长的随访时间为7年，亚组中有8名患者。观察期中位数为1（0 ~ 7）年，平均为2.9（±2.6）年。使用流体衰减反演恢复序列与铁敏感MRI相位数据融合获得图像，称为FLAIR-SWI，以及磁化制备的两个快速采集梯度回波，称为MP2RAGE。通过人工分割评估有和无铁环病变的体积和T-1松弛时间。通过对17例死后患者（10例女性，2例复发缓解型，13例继发进行性和2例原发性进行性多发性硬化症）的针对性组织学分析，证实了铁环外周围斑块信号改变的病理基础，中位年龄66岁（34-88岁），其中4例有死后7t MRI数据。我们观察到16个新生铁环病变，主要形成于复发缓解型多发性硬化症。复发缓解型患者的铁环病变比例明显高于进展型患者(17.8% vs 7.2%
Recent data suggest that multiple sclerosis white matter lesions surrounded by a rim of iron containing microglia, termed iron rim lesions, signify patients with more severe disease course and a propensity to develop progressive multiple sclerosis. So far, however, little is known regarding the dynamics of iron rim lesions over long-time follow-up. In a prospective longitudinal cohort study in 33 patients (17 females; 30 relapsing-remitting, three secondary progressive multiple sclerosis; median age 36.6 years (18.6-62.6), we characterized the evolution of iron rim lesions by MRI at 7 T with annual scanning. The longest follow-up was 7 years in a subgroup of eight patients. Median and mean observation period were 1 (0-7) and 2.9 (+/- 2.6) years, respectively. Images were acquired using a fluid-attenuated inversion recovery sequence fused with iron-sensitive MRI phase data, termed FLAIR-SWI, as well as a magnetization prepared two rapid acquisition gradient echoes, termed MP2RAGE. Volumes and T-1 relaxation times of lesions with and without iron rims were assessed by manual segmentation. The pathological substrates of periplaque signal changes outside the iron rims were corroborated by targeted histological analysis on 17 post-mortem cases (10 females; two relapsing-remitting, 13 secondary progressive and two primary progressive multiple sclerosis; median age 66 years (34-88), four of them with available post-mortem 7 T MRI data. We observed 16 nascent iron rim lesions, which mainly formed in relapsing-remitting multiple sclerosis. Iron rim lesion fraction was significantly higher in relapsing-remitting than progressive disease (17.8 versus 7.2%; P